Utilization Review Specialist at Clearfork Academy

Fort Worth, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

30 Mar, 26

Salary

0.0

Posted On

30 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Communication Skills, Analytical Skills, Problem-Solving, Collaboration, Electronic Health Records, Attention to Detail, Organizational Skills

Industry

Hospitals and Health Care

Description

Description The Utilization Review Specialist at CLEARFORK ACADEMY is responsible for advocating for insurance authorizations and clinical appeals by reviewing and evaluating medical records to support medical necessity. This role ensures appropriate level of care, length of stay, and compliance with existing authorizations or denials while supporting clients throughout their treatment process. Key Responsibilities Advocate for initial authorizations and clinical appeals with insurance providers based on medical necessity, level of care, and length of stay. Review and evaluate client medical records, treatment plans, and clinical documentation to support authorization and appeal requests. Monitor client charts and records concurrently with treatment to ensure continued authorization and compliance. Request, track, and document approvals, denials, and appeal outcomes from insurance companies. Collaborate with clinical staff to ensure accurate and timely documentation that supports utilization review needs. Collect, compile, and maintain utilization review data in accordance with organizational policies, regulatory requirements, and payer guidelines. Ensure compliance with all applicable laws, regulations, and accreditation standards related to utilization review. Skills & Competencies Excellent written and verbal communication skills Strong analytical and problem-solving abilities Ability to work collaboratively with multidisciplinary teams Proficiency in electronic health records and documentation systems Requirements Qualifications Experience in utilization review, insurance authorizations, or clinical appeals (behavioral health or healthcare setting preferred). Strong understanding of medical necessity criteria, levels of care, and payer requirements. Ability to analyze clinical documentation and communicate effectively with insurance providers. Strong organizational skills with attention to detail and accurate record-keeping. Familiarity with applicable healthcare regulations and confidentiality standards.

Responsibilities

The Utilization Review Specialist advocates for insurance authorizations and clinical appeals by reviewing medical records to support medical necessity. They ensure compliance with authorizations and collaborate with clinical staff throughout the treatment process.